Abstract: TH-PO264
Retrospective Analysis Comparing Atrioventricular Fistula Successful Use Rates for Hemodialysis (FUSH) at 6 Months to Prediction by Lok Failure-to-Mature Tool
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Alfarra, Rashed, East Carolina University, Greenville, North Carolina, United States
- Myers, Iskra, East Carolina University, Greenville, North Carolina, United States
- Parker, Joseph C., East Carolina University, Greenville, North Carolina, United States
Background
Atrioventricular fistula (AVF) is the preferred vascular access for dialysis patients. AVFs have high non-maturation rate. Lok et al, developed a clinical prediction tool to identify AVFs at risk for Failure To Mature (FTM). The equation includes patient’s age, race, presence of peripheral vascular disease (PVD), coronary artery disease (CAD), and has achieved good prediction accuracy with 69% failure rate in the highest risk category. We aimed to validate the Lok's FTM equation in our patients at East Carolina dialysis unit.
Methods
Retrospective chart review identified 43 patients who received AVF from 12/01/2009 to 12/01/2020 at ECU dialysis unit. Demographic and clinical data was obtained from electronic medical records. The primary outcome was AV FUSH at 6 months. The FTM equation risk score was retrospectively applied to our patient cohort and compared with the observed clinical outcomes using Receiver Operating Characteristic in SPSS v28.
Results
In total 43 AVFs were created during the study period. Mean age was 55 +/- 20 years, 89% were African American, 30% of the patients had CAD, 14% had PVD. FUSH at 6 months was 53.5%. We examined the external validity of Lok's model by applying it to our population. 22% of patients with lowest risk score had non maturation at 6 months. 14% of the patients with highest risk scores all lost access within one year of AVF creation despite having FUSH at 6 months.
Conclusion
Despite increased number of AVF creations since Fistula First Initiative, outcomes on maturation rates are suboptimal. Reasonable FUSH rates at 6 months can be achieved. FTM equation was not validated in our cohort. Possible reason is our population cohort (mostly African American) vs Lok's FTM cohort (mostly Caucasian population).